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S

sia

Hello everyone!

I desperately need some advice and this site looks like the best place to get it.

I'm going in for VR surgery very soon - probably sometime next week - and the doctors have offered me the choice between mechanical and bovine valves. The cardiologist said without hesitation that the mechanical is best, while the surgeon opts for the tissue valve.

I can't help but feel that each doctor has his own interest (and/or pocket) in mind here: the cardio wants me to continue visiting him, while the surgeon wouldn't mind me back on the operating table eventually. I guess I don't quite trust them or their judgements...

I'm 60 years old and while I don't expect to live forever, I want to be able to watch my newborn grandson grow up. I don't think I could go back into surgery ever again (the anticipation of it is making me sick) but at the same time the thought of Coumadin frightens me.

Can anyone offer me some advice?
sia.
 
Hi Sia,
I am 55 and had a mecanical valve plus aortic stem repair done at the end of February. My doctors advised me to go this route rather than asking what I wanted to do. I have to admit,though,that if I was asked to chose I would probably make the same choice again as I do not want to go through surgery again if at all possible.
However some argue that they decided on a tissue valve figuring that improvements in surgery in the next ten years might make a second surgery easier to take. Seems like a gamble to me.
The down side is the coumadin and the noise of the valve. The coumadin is a worry at times as you are juggling dosage, and diet. Also you have to go in and give a blood sample on a regular basis. (some members here do self testing and I may try that in the future) I am probable eating better than I ever have because I am so conscious of what's going in. (many foods actually taste better with less salt and grease)
The noise is suprisingly easy to get used to, and not audible in a group of people. (I think during quiet scenes at a movie or play the person in the next seat could probably hear it). My wife can hear it at night but says she finds it soothing. When I need to take a pulse its not hard to find.
Hope this is of some help.
 
Hi Sia

I'm 43 and the owner of 2 mechanical valves for nearly a month. I think the key statement in your post for me is
I don't think I could go back into surgery ever again (the anticipation of it is making me sick)
Click to expand...

I also wanted to avoid any future surgeries, and at 43, I might be looking at as many as 2 reoperations if I went with tissue valves. Because of other medical issues and suspected scarring of the valve roots I was only offered mechanicals anyway, but this was OK because I planned to push for them anyway.

Don't sweat the coumadin. I'm just now getting up to speed on the testing, but getting a good solid level has been pretty easy. Like Tom, it has forced me to pay attention to what I eat (for me this is truly a good thing), and to be fairly consistent in my diet. You do have to pay attention to your INR with diligence.

Having 2 valves, I sound like a bit like a pocketwatch. TICK-tick, TICK-tick. They are VERY QUIET and not noticeable in normal surroundings. I have to be in a small, very quiet room to hear them myself. Like Tom's wife, mine likes hearing them at night and gets a big smile on her face when she hears them.

I hope this is of some help.
 
Hello sia and welcome to the club er, family.

The choice you make in valve selection, is a personal thing that only you can really decide upon. The Coumadin thing isn't that big of a deal. Yes, you have to have your blood checked (Protime or INR) and watch your diet. Watching your diet does not mean that you stop eating the foods you like, but eat sensibly and with consciencenous as to what your eating. It's sort of like taking a vitamin everyday really.

I'm 40 and about to have AVR next month.
My choice is mechanical, though I may not be able to have it and may have to settle for a tissue valve. I had a ruptured aneurysm and a Ross procedure done, with a good bit of my aortic root replaced, so anatomically, they'll have to wait and see once they get in there to determine if I can go with the mechanical. This will be my 2nd surgery and I really don't want a 3rd if I can have any say in the matter. Don't forget that with each surgery, things get harder to deal with as far as adhesions and scar tissue from the surgery before.

Given your age, you could probably go either way, tissue or
mechanical, but if I were in your shoes, I'd choose mechanical.
There is something about aging and experience that says, "I don't want to go through surgery again, ten or so years down the road."

Again, the Coumadin/Warfarin thing is not as terrible as it sounds. I'm already on it for DVT and I haven't changed my diet much at all. I just have to watch how much green veggies I eat, that seems to be my little quirk. Al Lodwick, our resident pharmacist, has an excellent site that deals with Coumadin/Warfarin that I think you should at least check out for yourself. Below is the link.
http://www.warfarinfo.com/warfarinfo.com2.htm
The main page can be found here:
http://www.warfarinfo.com/default.htm

If you have more fears, questions, or just need to talk, we are all here. Again, welcome aboard. :)
 
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You have to trust one of them

You have to trust one of them

Sia,

I know it's difficult to overcome the physical and emotional stress you are currently under.

Did you read the replys in the thread titled "Anyone ever regret the type of valve they chose?" on this forum? Perhaps many of your questions will be answered there.

Regards.
 
Hi Sia,
Welcome to this great site!
The confusing thing about this whole process is that there is no right or wrong answer. I had aortic valve replacement in '99 at the age of 45. I received different opinions from well-known cardiac surgeons. One told me I should only consider mechanical, and the other told me I should only have a tissue valve. I found a third who told me he could do either, and let me choose. I chose a homograft. There was a study from Duke University several years ago where they surveyed their valve replacement patients to see if they were happy with the choice (mechanical or tissue valve). The great majority (I think about 90%) were satisfied with the choice they made. So good luck! You just have to go with what feels right for you.
 
Hi Sia,

Welcome to our family. Pull up a chair and feel like you are amongst friends who care.
Choosing a valve is very personal and there is no wrong and no right way to choose.
I had no idea about valves and took the surgeons advice about getting a mechanical valve. He told me that you don't want to do this surgery too many times as it gets harder each time to deal with the scar tissue, plus as we age it takes a lot longer to recuperate from something like this.
I have a St. Jude's mechanical but this is my second mechanical valve already. I had surgery in August of 2000 but the surgery needed to be redone within 11 days because of a blood clot that had formed underneath the valve. (Read my story in the personals with all the details) My first mechanical was a Sultzer Carbomedics and it was a loud valve. I would have had a difficult time getting used to that valve, but because the surgery needed to redone the surgeon chose another brand and implanted the St.Jude's. I have been happy with this valve. It is not loud and I can only hear it when I lay down to sleep and listen very carefully.
Coumadin can be scary at first before it is stable. You need to find yourself a doctor who knows how to regulate Coumadin, otherwise your numbers will go up and down and it will give you a lot of anxiety to deal with. Many things like OTC meds, alcohol and green vegies will interfere with Coumadin. This doesn't mean you can't have them, but within reason. I eat greens every day!
I also have the protime home testing machine and it is in one word "wonderful". It gives me freedom to take the machine wherever I want to go and not have to worry how to get to a lab to test.
Please come back often and ask as many questions as you like. We understand you are under a lot of stress at the moment, but we'll be here to help you every step of the way until you get over the mountain. After it is all over you'll say, "hey, this wasn't as bad as I thought it would be" and you will be correct. It really is not as bad as you think it will be, plus you'll start feeling much better after a few weeks.

Hope this helps.

Christina
Congenital Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's Mechanical
 
Hello Sia,

So glad that you joined us. I had surgery in the year 2000 and choose a homograph. ( this is a human cadava valve) I was 49 at the time and am glad I made this decission. What you are going through right now is the hardest. As many in this group will tell you although it is no walk in the park, it realy isn't that bad. My decission was based on the fact of coumadin and the ticking both I new I could not put up with. Yes, it is true in how many years I will have to go through this again. However, at that time there will be new improvements. Good luck with this decission, if I can be of any further help please let me know. martha
 
Hi Sia:

I am fifty years old and I am 4 weeks into my recovery from AVR. According to my surgeon, a mechanical valve was the only way to go. The clicking is not really a bother. I would rather hear it then suddenly not! Coumadin is coumadin. It is the price we pay for the long life of the valve (and us too). I am sorry that you do not seem to trust your doctors. Trust was something I looked for in my surgeon (Dr. John V. Conte,JHU Baltimore MD). These people literally have your life in their hands. Good luck with your surgery :)
 
Hi Sia - It is great to have you as part of our forum. The big question you ask is one that we hear so often. It seems that both options are good and that it is a matter of which is better for you. I chose a homograft for my aortic and repair for my mitral. I have now avoided coumadin for 15 months. I am also hoping these human valves last longer than the bovine. I will have a better opinion in about ten years. If I were you, I would look at the coumadin section to see if there are things being discussed that would bother you. Good luck with your decision.
 
hi sia!
welcome to this site. as you can see, it takes no time for someone to come forward and help.
this is a great place; everyone is so caring, supportive and informative.
i really don't have much to add to what the others have said; they're all right_ there is no wrong answer, no wrong valve.
my husband, joey (turning 50 in 2 months!) did not want to go the coumadin route. when we thought there might be a problem with his new aortic valve,however, he said that if they had to open him up again, he would opt for a mechanical and would bite the bullet and do the coumadin. he felt that he never wanted to have to go through this surgery again.
my dad had avr and bypass surgery 3 yrs ago at the age of 66 and _thank God_ has been doing great with his st. jude's mechanical valve and his coumadin.
from everything i've read here, it is the non-coumadin takers who seem to mind it more than the coumadin takers.
good luck in your decision and please let us know what you decide to do. please remember, there are no wrong answeres here.
be well, sylvia
 
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Not so simple

Not so simple

Hi Sia,
This is a great group for getting a variety of "real world" experences and a variety of opinions.

Too often, unfortunately, the choice between a mechanical and a tissue valve is presented as
1) the mechanical which reduces chance of another surgery but requires blood thinners, versus
2) the tissue valves, which may not last as long, but do not require blood thinners.

In fact, the choice is far more complicated.

Mechanical valves are incredibly durable; however, the chance of a thromboembolism (stroke) is higher--even with blood thinners-- than a tissue valve. You can look up for different mechanical valves the annual incidence of thromboembolitic events. Second, the failure mode (how a valve fails) is different between mechanical and tissue valves. A mechanical valve (note that modern valves are incredibly reliable) can fail catastrophically all at once. A tissue valve tends to begin to fail slowly, over quite a period of time, and can be detected usually through echocardiogram.

Also, some valves have better hemodynamics (the ability to allow blood to flow naturally and effectively) than others. Your lifestyle will make a difference.

There is no "perfect" choice. Your surgeon's experiences and judgement should be considered carefully, but note that you can go to three different excellent surgeons and come away with three different opinions as to "what's best." Educate yourself as best you can, don't be afraid of second or third opinions, and finally, remember that this is YOUR choice. Whatever you decide will not be a bad decision...there really are no bad decisions regarding this. There are, though, tradeoffs and compromises to be made. Keep asking questions, do your homework, and whatever choice you then make will work for you.

Best wishes,

--John
 
I too was afraid of mechanical valves due to the Coumadin issue. However, at age 49 when my surgery was done 30 months ago, a tissue valve probably would have meant at least 2 additional surgeries during lifetime. So I went the mechanical/coumadin route and have not regretted it for an instant.

The coumadin was not as bad as I thought it would be. I was relatively easy to stabilize, which is highly dependent upon consistency in diet and other medicatons. I switched over to home testing about 6 months ago and feel in total control of my INR.

You need a progressive doctor to go the home testing route and a firm desire to take control of the situation. Coumadin can be a nightmare if mismanaged or it can be "no big deal" if done correctly. Its really up to you. I did not want to be "opened up" again if it could be avoided. Weighing the two options, I'd rather be on Coumadin then go through a 2nd or 3rd surgery. Good luck with your choice.
 
Hi,

I'll just throw in my two cents. I had the Ross
Procedure performed in December, 2000 by the same surgeon that performed Arnold Schwartzenegger's surgery. One of the leaflets on my new transplanted aortic valve began to prolapsed after 4 months. I never had any symptoms. I am a runner who still runs 3 miles a day. At any rate, I will probably looking at another surgery sometime in the near future. My surgeon recommended a homgraft for the "redo". I got a second opinion from another world class who performed the first successful heart lung transplant and he recommended the synergraft tissue valve if and when I need another surgery. My cardiologist has recommended a mechanical. Sooo, I still am undecided about my selection. As it has been mentioned before by people who are on coumadin, coumadin is usually not that big of a deal. On one hand, I would like to make the next surgery my last. On the other hand, I like the idea that in addition to not taking coumadin, my active lifestyle will not change and if the tissue valve does fail, it is usually a slow process that can be caught with a echocardiogram. I realize that with each subsequent surgery, scar tissue becomes a bigger issue. However, I find it interesting that both surgeons did not seem to be too concerned about the scar tissue. The bottom line is if the thought of having future surgeries causes you a tremendous amount of anxiety, I think you should go with the mechanical. I believe either choice will give you a better quality of life.

God Bless.
 
Bruizer,
I'm a runner too, and about to have the CryoLife SynerGraft aortic valve implanted. If you want more information about this option, feel free to email me at:
[email protected]

I've been in close contact both with CryoLife and the small number of surgeons who are doing this valve. My surgery will be a minimally invasive one (mini-sternotomy).

Best,
--John
 
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Same decision is required

Same decision is required

Sia

I had my mitral valve replaced with a porcine valve in Nov 1991 (34 years old). I have had the best 11 years of my life - bar none. Last month, my doctor's told me that it has started to deteriorate and I will need another procedure for a new valve. So, I am in the same decision as you, but the decision for a porcine/bovine for me means that there will be a third surgery (and the risks therein).

If you can live with the thought of a second procedure - which was easy for me up until the last month:) then based upon my experiences, I recommend the porcine/bovine.
 
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